title: [Vitamin-resistant rickets cured by removal of a bone tumor. Review of the literature].
abstract: OBJECTIVE
  Rickets secondary to bone or soft tissue tumors are rare in children. Majority of the reported cases occurred in adults older than thirty. This entity can be cured after tumor removal. The authors present a case in a ten year boy and literature review.
  
  
  METHODS
  A ten year boy complained of diffuse bone and muscle weakness for two years. A diagnosis of arthritis was made but the patient continued to complain. Serum calcium level was normal (2.33 mmol/l), phosphorus was very low (0.43 mmol/l), serum alkaline phosphatase was high, parathyroid hormone and vitamin D level were normal. Urinalysis showed abnormal phosphate excretion.
  
  
  METHODS
  The absence of malabsorption, no family history of rickets or hypophosphatermy presence of a marked excess of urinary phosphate, very low serum phosphate and normal serum calcium, vitamin D and parathyroid hormone levels led us to consider a diagnosis of tumor induced osteomalacia. Radiographs showed a large round radiolucent lesion in the left superior pubic ramus and generalized demineralisation.
  
  
  RESULTS
  We performed a complete tumor resection and the space was filled with bone graft. On histopathologic examination it was a benign mesenchymal tumor. Rapid reversal of biochemical anomalies, radiographs anomalies and clinical manifestation were observed after complete tumor resection.
  
  
  CONCLUSIONS
  The authors have described the tumor, the osteomalacia and the pathogenesis of tumor rickets. Histologically the most common causative tumors were vascular tumors, mesenchymal tumors and non ossifying tumors. The tumor were of bone or soft tissue origin. Clinical symptoms were muscular weakness, bone and muscle pain. Biochemically there is a very low phosphate level, a normal serum calcium level as well as a normal vitamin D and PTH level. There is a significant high level of urinal phosphate. The mechanism proposed to explain oncogenic osteomalacia includes tumor secretion of phosphaturic substance other than PTH and calcitonin. Another hypothesis is a substance interfering with normal vitamin D metabolism. The pathogenesis is not clearly defined.
  
  
  CONCLUSIONS
  Regardless to the mechanism of osteomalacia, complete removal of the tumor will cure the patient. A diligent search for tumors should be done in patients with vitamin D resistant rickets.
authors.affiliation: Service de chirurgie pédiatrique, American Memorial Hospital, Reims.
authors.forename: S
authors.initials: S
authors.lastname: François
authors.forename: G
authors.initials: G
authors.lastname: Lefort
authors.forename: M L
authors.initials: ML
authors.lastname: Poli-Merol
authors.forename: D
authors.initials: D
authors.lastname: Gaillard
authors.forename: B
authors.initials: B
authors.lastname: Roussel
authors.forename: V
authors.initials: V
authors.lastname: Sulmont
authors.forename: S
authors.initials: S
authors.lastname: Daoud
mesh_terms: D001859:Bone Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002648:Child; D004351:Drug Resistance; D005500:Follow-Up Studies; D006801:Humans; D007015:Hypophosphatemia, Familial / Q000209:etiology / Q000628:therapy*; D007085:Ilium; D008297:Male; D010760:Phosphorus Metabolism Disorders / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D011859:Radiography; D014807:Vitamin D / Q000378:metabolism
chemical_list: D014807:Vitamin D
vernacular_title: Rachitisme vitamino-résistant guéri par l'éxérèse d'une tumeur osseuse. Revue de la littérature.